Ding Jiangbo, Chang Xuying, Ma Peiyu, Yang Guangwu, Zhang Ruoyu, Li Yuanyuan, Lei Ting, Mu Linjie, Zhang Xingkui, Li Zhigao, Tang Jinwei, Tang Zhiwei
Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan Province, China.
Department of Neurosurgery, South Yunnan Central Hospital of Yunnan Province (The First People's Hospital of Honghe Prefecture), Mengzi, 661199, Yunnan Province, China.
BMC Neurol. 2024 Jun 12;24(1):198. doi: 10.1186/s12883-024-03707-y.
At present, the most effective treatment for symptomatic moyamoya disease (MMD) is surgery. However, the high incidence of postoperative complications is a serious problem plaguing the surgical treatment of MMD, especially the acute cerebral infarction. Decreased cerebrovascular reserve is an independent risk factor for ischemic infarction, and the pulsatility index (PI) of transcranial Doppler (TCD) is a common intuitive index for evaluating intracranial vascular compliance. However, the relationship between PI and the occurrence of ischemic stroke after operation is unclear.
To explore whether the PI in the middle cerebral artery (MCA) could serve as a potential predictor for the occurrence of ischemic infarction after bypass surgery in MMD.
We performed a retrospective analysis of data from 71 patients who underwent combined revascularization surgery, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS). The patients were divided into two groups according to the median of ipsilateral MCA-PI before operation, low PI group (MCA-PI < 0.614) and high PI group (MCA-PI ≥ 0.614). Univariate and multivariate regression analysis were used to explore risk factors affecting the occurrence of postoperative cerebral infarction.
Among the 71 patients with moyamoya disease, 11 patients had cerebral infarction within one week after revascularization. Among them, 10 patients' ipsilateral MCA-PI were less than 0.614, and another one's MCA- PI is higher than 0.614. Univariate analysis showed that the lower ipsilateral MCA-PI (0.448 ± 0.109 vs. 0.637 ± 0.124; P = 0.001) and higher Suzuki stage (P = 0.025) were linked to postoperative cerebral infarction. Multivariate analysis revealed that lower ipsilateral MCA-PI was an independent risk factor for predicting postoperative cerebral infarction (adjusted OR = 14.063; 95% CI = 6.265 ~ 37.308; P = 0.009).
A lower PI in the ipsilateral MCA may predict the cerebral infarction after combined revascularization surgery with high specificity. And combined revascularization appears to be safer for the moyamoya patients in early stages.
目前，症状性烟雾病（MMD）最有效的治疗方法是手术。然而，术后并发症的高发生率是困扰MMD手术治疗的一个严重问题，尤其是急性脑梗死。脑血管储备降低是缺血性梗死的独立危险因素，经颅多普勒（TCD）的搏动指数（PI）是评估颅内血管顺应性的常用直观指标。然而，PI与术后缺血性卒中发生之间的关系尚不清楚。
探讨大脑中动脉（MCA）的PI是否可作为MMD搭桥手术后缺血性梗死发生的潜在预测指标。
我们对71例行联合血运重建手术的患者的数据进行了回顾性分析，包括颞浅动脉-大脑中动脉（STA-MCA）吻合术和脑-硬膜-肌-联合血管吻合术（EDMS）。根据术前同侧MCA-PI的中位数将患者分为两组，低PI组（MCA-PI＜0.614）和高PI组（MCA-PI≥0.614）。采用单因素和多因素回归分析探讨影响术后脑梗死发生的危险因素。
在71例烟雾病患者中，11例在血运重建术后1周内发生脑梗死。其中，10例患者同侧MCA-PI小于0.614，另一例患者的MCA-PI高于0.614。单因素分析显示，同侧MCA-PI较低（0.448±0.109 vs. 0.637±0.124；P = 0.001）和铃木分期较高（P = 0.025）与术后脑梗死有关。多因素分析显示，同侧MCA-PI较低是预测术后脑梗死的独立危险因素（校正OR = 14.063；95%CI = 6.265～37.308；P = 0.009）。
同侧MCA中较低的PI可能以高特异性预测联合血运重建手术后的脑梗死。对于早期烟雾病患者，联合血运重建似乎更安全。
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